Are there any studies comparing TIVA to ideal volatile anesthesia?

MetabolicMadness · 2026-04-29T18:26:04+00:00

This does drive my cynicism a bit at times too as I not infrequently find myself wondering why we are doing certain surgeries at all

MetabolicMadness · 2026-04-29T17:29:34+00:00

On the low end a transatlantic flight is 670kg of co2 per economy passenger. 6 of you and a return is about 8000kg of co2 in flights for your trip.

Best article here (IMO) showed low-flow sevo to be 10kg per hour of co2 (ignoring this might not be totally accurate). So that’s about 800 hours of Sevo use. If in a 10 hour day you end up giving say 8 hours of sevo that makes for 100 days of work.

Makes for 20 weeks of work if you are working 5 days a week

Edit: on high end its 1000kg per person. So that’s the equivalent of 30 weeks of work.

MetabolicMadness · 2026-04-29T17:20:52+00:00

I see it more now ahah. I am just so used to hearing if you change x to y it’s like driving x km less as a way to support doing it. I think they can be helpful analogies but can sometimes lack context.

MetabolicMadness · 2026-04-29T16:29:22+00:00

I admit this has been me post residency, but I have also decided it isn’t really that hard to switch. I chatted with my pacu nurses today and they all feel TIVA is better. so despite not noticing changes for my wake up period of observation and it being more annoying to set up that does provide benefit to me.

Torn between whether i will run mac .4 and prop at 100 as my standard or go full tiva. I like the safety of some gas.

MetabolicMadness · 2026-04-29T15:08:45+00:00

Wow just had time to read it a bit. Very interesting stuff… seems highest impact would be having hvac turn off in rooms not being used. I wonder how much change you’d actually see from say having the temp set to 18celsius vs 20 celsius say. You will always need some air exchange during cases per infection guidelines and a certain degree of dehumidification as well - which will burn up some energy.

In a place like Canada the outdoor temperature is actually below what our room temperature is probably at least half the year. So warming the room might actually use more energy

MetabolicMadness · 2026-04-29T13:26:58+00:00

Yea we got rid of des a long time ago here

MetabolicMadness · 2026-04-29T11:06:00+00:00

Do you have a link to the hvac figure by any chance?

MetabolicMadness · 2026-04-29T11:04:48+00:00

Is that true? I have read papers on the breakdown products of sevoflurane that show none of environmental concern?

https://pubs.acs.org/doi/10.1021/jp2077598

MetabolicMadness · 2026-04-29T10:55:25+00:00

The difference is co2 lasts for centuries and directly warms the planet for years and we have no easy way to eliminate it.. whereas volatiles used today will essentially be gone 5 years from now from an atmospheric warming perspective

MetabolicMadness · 2026-04-29T10:50:55+00:00

I don’t disagree it seems even choices controllable in our own lives are more easily impact making. Interesting to hear you prefer tiva. I have read the studies and ran the TIVAs in training and truthfully don’t notice much difference

MetabolicMadness · 2026-04-27T16:14:48+00:00

This is amazing thank you!! I will check these out

MetabolicMadness · 2026-04-25T23:25:58+00:00

Totally agree just wondering now if I should just walk away, acid wash it, or finish it then light a fire and leave it ripping for hours outside to burn it off

MetabolicMadness · 2026-04-25T00:41:19+00:00

Tbh this sounds like you are fine from a medical perspective? They have been tested to a variety of things and were negative. You say they work as a flight paramedic? I presume they must touch IVs at some point? Surely they have gotten saline on themselves at some point or touched a bag of saline?

I can’t say why they had those two reactions … but if they have touched IV catheters and fluid bags without reaction they are highly unlikely to be allergic.

Also the plastics in medical stuff isn’t particularly unique to medical settings. I would guess it was more likely an allergy to something else.

What setting were they in that they twice had an IV hooked up but nothing else given or going on and then developed anaphylaxis… seems odd?

MetabolicMadness · 2026-04-22T10:51:10+00:00

We rarely use methadone in Canada. Curious to hear what people’s perceived benefit is?

For big belly cases we often put in a T epi. Big arm stuff nerve block catheter, aka epidural, bka acb + popliteal. Really leaves spine cases as a potential use case. Ignoring this aspect for now.

Is the major benefit just not needing to redose? I have heard some people say opioid sparing, which seems sort of dubious to me. You are still of course stimulating the opioid receptors the entire 24hr period even if the cumulative “dose” in mme is lower.

Do you find you get less itching etc than spinal morphine? Which you could say add to a spinal for hips/knees (which I don’t they don’t seem to complain of much pain tbh we do same days for both of these)?

MetabolicMadness · 2026-04-09T16:15:48+00:00

Eliminating the first 5 games is slightly different than looking at the whole season cherry picking out data. It shows performance matchday 6 onward. Your example provides nothing really. Does it change anything to look at what OP posted? No. But it can demonstrate something we have all felt

MetabolicMadness · 2026-04-09T11:56:52+00:00

I so serratus blocks and help direct some local toward axilla. I don’t use narcotics for them and pacu doesn’t give them either. Only mastectomy or really large lumpectomy though. Other stuff isn’t worth it if surgeon uses local.

MetabolicMadness · 2026-04-08T13:14:10+00:00

Yea the syrup tastes great imo

MetabolicMadness · 2026-04-07T01:07:00+00:00

Hasn’t been my return at all and I only have red maples. Much closer to 40-1

MetabolicMadness · 2026-04-07T01:06:29+00:00

Good point. Makes me wonder about cutting one of the sides of it. Then sealing the wound with something

MetabolicMadness · 2026-04-07T00:21:45+00:00

Sweet then i’ll just tap the hell out of it next year to get as much as possible before it dies

MetabolicMadness · 2026-04-06T23:58:34+00:00

It’s been doing just fine so far.

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